Organization
JACKSONVILLE ORAL SURGERY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE COLE (VP INSURANCE PLAN MANAGEMENT)
(419) 553-1509
Entity
Organization
Contact information
Practice address
2047 PARK ST, JACKSONVILLE, FL 32204-3809
(904) 388-7665
Mailing address
2047 PARK ST, JACKSONVILLE, FL 32204-3809
(904) 388-7665
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
01/17/2020
Last updated
01/17/2020
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